Case history
Case history #1
A 56-year-old obese woman presents to the emergency department with a history suggestive of biliary colic, including epigastric discomfort after a heavy meal. Her past medical history includes cholelithiasis, hypertension (treated with an angiotensin-converting enzyme [ACE] inhibitor), and dyslipidaemia (treated with a statin). She is an ex-smoker, drinks alcohol socially, and has no significant family history. On palpation of her abdomen, she has right upper quadrant pain, but there are no other relevant findings on examination. An abdominal ultrasound is performed, which demonstrates the presence of gallbladder stones without obstruction, and an incidental 5-cm, left-sided renal mass.
Case history #2
A thin 65-year-old man with no significant past medical history presents with a 5-month history of right-sided flank discomfort and abdominal fullness. He finally seeks medical attention because of 2 weeks of lower extremity oedema, and 4 days of gross haematuria with clots. On examination, his blood pressure is 160/90 mmHg, heart rate is 120 bpm and regular, and he is afebrile. He is found to have a palpable right-sided lower abdominal mass, and pitting oedema to the mid-shins bilaterally, which is worse on the right.
Other presentations
Evidence suggests over 50% of people with RCC are asymptomatic on presentation, and renal masses are often found incidentally on imaging done for other indications.[1][2] If present, symptoms may include abdominal pain, haematuria, oedema/ascites from inferior vena cava disruption, and scrotal varicocele in males. The classic triad of flank pain, haematuria, and abdominal mass is uncommon, occurring in <5% of patients, and suggests a larger size of tumour, higher pathological stage, and worse prognosis.[1][16] Symptoms from metastatic disease may include respiratory symptoms (e.g., persistent cough) and bone pain, depending on site of disease.[17] Paraneoplastic symptoms (e.g., humoral hypercalcaemia of malignancy, paraneoplastic hypercortisolism resulting in Cushing’s syndrome, polycythaemia due to inappropriate erythropoietin production) are found in 10% to 40% of patients with RCC.[18]
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